Initial symptoms of manic episodes in patients with bipolar disorder

This study examined the frequency, order of onset, severity, and duration of manic and psychotic symptoms in the most recent manic episodes of patients with bipolar I disorder, based on self-reports and caregiver observations. A cross-sectional, descriptive design was used. The sample consisted of 46 patients diagnosed with bipolar I disorder and their 46 caregivers. Participants completed a sociodemographic and clinical data form, the Montgomery–Åsberg Depression Rating Scale, and the Young Mania Rating Scale. Data were analyzed using SPSS. The most frequently reported symptoms by patients were decreased need for sleep, increased speech, and heightened goal-directed activity. In terms of symptom onset, decreased sleep, irritability, increased speech, and elevated self-confidence were most common. Grandiose, persecutory, and jealous delusions were the most frequent psychotic symptoms, while auditory and visual hallucinations were predominant. Grandiose, persecutory, and religious delusions appeared first, followed by auditory and visual hallucinations. Caregivers similarly reported decreased sleep, increased speech, and elevated self-confidence as the most common symptoms, with a largely overlapping order of onset. Grandiose, persecutory, and referential delusions, along with auditory and visual hallucinations, were most frequently reported among psychotic symptoms. Comparison of patient and caregiver reports revealed perfect agreement for decreased sleep, goal-directed activity, irritable and elevated mood; almost perfect for increased speech and risky behavior; and substantial agreement for self-confidence, flight of ideas, and distractibility. Regarding delusion types, perfect agreement was observed for jealous delusions, while almost perfect agreement was found for grandiose and persecutory delusions. Substantial agreement was observed for auditory hallucinations, perfect agreement for visual ones, and perfect agreement regarding the reported onset of hallucinations. Additionally, elevated self-confidence appeared earlier in patients under 40; increased speech in those not using psychotropics; increased activity in those not using mood stabilizers; and irritable/elevated mood in valproate users. In conclusion, the most common manic symptoms were decreased sleep, increased speech, goal-directed activity, and elevated self-confidence. In terms of their order of onset, the earliest symptoms that stand out are insomnia, irritability, increased speech, and elevated self-confidence. In clinical follow-ups, attention should be paid to these symptoms in order to predict recurrence and enable early intervention.